Back Pain and the Athlete

by Robin P. Smith, PT, Saint Vincent Outpatient Rehabilitation Center

Back pain - a simple phrase, until it affects you. Low back pain strikes 8 out of 10 adults at one point in their lives. Back pain has even made the sports pages, placing Mike Lansing, 2nd baseman for the Boston Red Sox on the injured reserves list and affecting Fred Couples on the PGA Tour. Both athletes have undergone the usual battery of tests and treatment options. Both are back in the game. Lansing batting 273 and Couples in the top 20 of the PGA.

What is the difference between their back pain and the pain that is encountered by the recreational athlete? First it is necessary to understand back pain. Back pain is classified in two categories, acute and chronic. Acute pain comes on suddenly. It is usually from doing something you should not be doing or from doing it in the wrong way. The pain usually lasts a short time. Chronic pain is recurring; any little movement can set it off and for whatever reason it tends to linger.

Figure 1

Although back pain is usually preventable, it can happen. Given that the lower back supports most of the body’s weight, injuries are bound to occur. The stability of the lower back depends on the integrity of the vertebral bodies and the intervertebral disks.

To understand the many ways you can injure your back, consider that each of us has between 24 and 25 bones in and around our backs, including the neck and chest areas, which are held together by ligaments and muscles. Throw in some major nerves, a few disks (which serve as shock absorbers), and joints that guide the direction of movement of the spine and stack them all up. Expect to twist and bend them in a multitude of directions, and try to imagine what might go wrong. You can sprain the ligaments, strain the muscles, rupture the disks, and irritate the joints. While logic would point to injuries from sports or traumatic accidents as the major cause of the pain, sometimes the simplest of movements will have painful results. In addition, arthritis, congenital disorders, poor posture, obesity and psychological problems due to stress can be the source of back pain. Complicating the picture is the fact that back pain can also directly result from internal problems such as kidney stones, kidney infections, blood clots, or bone loss.

Back pain can have significant effects on athletes. Depending on the sport, incidence of back pain can occur in 1 - 30% of athletes. Idiopathic scoliosis and spondylolysis (a stress fracture of the posterior vertebral elements) are common back injuries in athletes. Frequent overloading of lumbar extension and the end range can cause spondylolysis. High-risk sports for this include gymnastics, dancing and figure skating, wrestlers, offensive lineman and divers. Most sports are one sided dominant, such as golf, baseball, tennis. Coupled with high impact, if appropriate training measures are not taken, back pain can occur.

Although reasons for recovery are different, the physiology and mechanics of repair of injured soft tissue in the athlete is the same as for the non-athlete.

Think of your spine as an extension of the equipment needed to play a sport. In your gym bag you have the latest running shoe, the most aerodynamic design for your bike, the right club for the right shot. Why not include flexible joints, excellent core trunk muscle strength and greater endurance to finish the game?

Neutral Spine
Your pelvis is the base of support for the entire spine. Learning to control or stabilize your pelvis is the key to avoiding injury. Control of the pelvis comes from muscles that attach in that area. Specifically those muscles are the abdominals (stomach), gluteals (buttocks), and spinal extensors (back muscles). When abdominals and gluteals contract they tip the pelvis backward and flatten the back. When the spinal extensors contract they tip the pelvis forward and increase the curve or arch the back. The joints of the spine, just like other joints in the body, work best and have the least potential for pain when they are in their mid range positions. The overall condition of your muscles can affect your ability to get into and maintain the neutral spine position. For example, weakness of abdominals and/or tightness of the hip flexors can cause an increased arch in the low back. Tightness of hamstrings and/or spasms in the spinal extensors can cause the low back to be too flat.

Figure 2

Caring for Your Back

Flexibility, strength and overall conditioning directly affect the health of your spine. Stretching is probably the most neglected of the three. Bob Anderson’s, Stretching, is a recommended source for guidelines for joint and sport specific stretches. Below are a few recommended stretches for the low back area.

Figure 3

Strengthening the core trunk muscles is critical to injury prevention. The major muscles targeted are the abdominals (lower and obliques), gluteals, back extensors, latissimus dorsi and quadriceps.

Endurance must also be included in your training regiment. Most training is considered sports specific, i.e.; the mode of training mimics the actual event. Overall conditioning has some carryover. Cross training techniques can increase your overall endurance and performance. Alternating aerobic exercise 3-4 days per week at 30-45 minutes per session can be beneficial.

Figure 4

Whether you are Joe Montana or Montana Joe, you can incorporate preventative measures into your training routine to avoid back injuries. It is also important that if you do have a back injury you consult with the appropriate health care professional for some sports specific guidance on your road to return to the sport and all other activities. Remember - flexibility, strength, endurance and finding and keeping neutral spine are all-important components to your program.

Robin Peterson Smith is a Physical Therapist at the Outpatient Rehab Center for Saint Vincents Hospital. She has 18 years experience and specializes in Orthopedic Physical Therapy.